Thinking about catheter vs incontinence
I'm making my first attempt at blogging because I have some decisions to make and could use some input from those who have experienced what we are going through. My husband, Lauren, had a large right sided stroke in Dec of 2010. He has many deficits, is wheelchair level mostly, and requires full time care. He can walk with help of one person and a second to bring up the wheelchair when he tires. He is not strong enough to walk functionally, only to get him up and keep trying to increase his strength. He needs help to transfer, bathroom, shower, dress. He eats independently and can brush his own teeth and shave. The rest requires help or cueing to accomplish. He has been incontinent pretty much since his stroke. For a while he was able to make it to the BR occasionally but never consistently. He has an enlarged prostate that complicates everything. Our biggest medical problems since stroke have been related to bladder infections. Several months after his stroke he developed retention which caused severe reactions in him. His spacticity (tone) kicked up big time and he was just wild with discomfort. A trip to the ER and his first catheterization yielded an output of 800 cc's. Every effort to get him off the catheter since has been unsuccessful. So he has a catheter in which causes repeated UTI's that require hospitalizations and IV antibiotics. The last one was urosepsis--it got into his bloodstream--and he was very sick. The urologists say the retention is a result of his stroke.
We went to a specialized urologist who works primarily in bladders affected by neurological issues. He had nothing to offer us. Lauren has an overactive bladder and our options are catheter or have me straight cath him routinely throughout the day and try to leave the long term catheter out. If I choose to straight cath him it is likely he will "leak" so will be regularly wet. The option of doing the catheter through the abdomen (suprapubic) is apparently out because he has previously had a diagnosis of bladder cancer and if the cancer ever returns, there would be an open portal from the bladder to the other organs.
Here's my dilemma: I have worked out a process of help that allows me to get away about once a week (his sister comes and stays with him) and I have a private duty aide who comes 3 nights a week so I can get sleep. She also showers and dresses him in the morning. Neither of these helpers will be able or willing to catheterize him. His sister had to do some heavy thinking to decide she would be able to help bathroom her brother. My daughter is the next level helper--again, how can I ask his daughter to catheterize him? So my entire support system will go out the window if I choose that option. This, of course, is the option the urologists want me to choose. To them, getting the catheter out is what needs to happen. Obviously, I want the infections to stop too. But I'm not sure I can handle the consequences of that choice.
Keep catheter in: he is dry and skin breakdown is kept to a minimum. Helpers around to ease the burden. Infections cause him to have multiple runs in hospital and IV antibiotics. Risk for him to someday develop a resistance to the antibiotics.
Take catheter out and straight cath as needed: leaking will lead to additional issues with skin breakdown, support system out the window. Minimize UTI's thus decreasing hospitalizations and IV antibiotics. He is on Coumadin so continued straight cathing throughout the day increases risk for injury and bleeding, especially with enlarged prostate.
In a about a week I will be taking him to the urologist again for a catheter change (has to happen once a month). I know he will be pushing me to try the straight cath route. Any wisdom to offer me as I consider these options?
Donna
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